Chapter 19: Advanced skills for pregnancy and birth
Sewing the rectal sphincter
If a woman’s rectal sphincter tears, she is at risk of never being
able to hold her stool in again. This is a very serious problem,
and it is very important that her sphincter is sewn well. If
possible, take the woman to a medical center or have
someone very experienced sew this kind of tear.
WARNING! Before you sew a torn rectal sphincter, check to
see if the wall of the rectum itself has torn. Do not try to
repair the wall of the rectum yourself. Get medical help
1. The sphincter muscle is inside a thin casing
of tissue called fascia. The muscle and
fascia may withdraw a little into the
Using a sterile forceps, clamp,
or tweezers, pull one end of
the muscle and fascia a little
so you can see them. Use a
second pair of forceps to pull
the other end of the muscle
so it sticks out a little too.
2. Use size 00 chromic gut or Vicryl suture
for sewing the sphincter muscle. Pull the
2 sides of the sphincter close together.
Insert the needle through the fascia and
muscle on one side and pull it out
through the other side.
3. Use 3 or 4 interrupted stitches to hold
the muscle and fascia together.
4. After the muscle is together, sew
the rest of the tear.
A Book for Midwives (2010)